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Definitions (81)
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workers' compensation coverage
This is insurance that employers are required to have to cover medical care of employees who get sick or are injured on the job.
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utilization review
This is a process of tracking, reviewing and rendering opinions about care. The practices of pre-certification, recertification, retrospective review and concurrent review all describe utilization rev [..]
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usual
Usual, customary and reasonable charges reflect the prevailing fees for service in an area. Many insurers and managed care plans reimburse providers based on UCR charges. This term may be synonymous w [..]
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uninsured patient
This is a patient without public or private health insurance. Mayo Clinic requires uninsured patients to make a deposit before receiving care.
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ub92/ub04
The UB92/UB04 form is required by Medicare and Medicaid and used by some private insurance companies and managed care plans for billing inpatient and outpatient hospital or facility charges. The offic [..]
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third-party administrator
Third-party administrators handle the administrative duties and sometimes utilization review for self-funded plans.
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tier network
With a tiered product, the member's benefit level of cost sharing is determined by the network of the independently contracted provider that renders the service. Keep in mind that an employer can [..]
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supplemental or secondary claim form
If you have supplemental or secondary insurance, Mayo Clinic will submit claims to those carriers on your behalf.
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supplemental insurance
This is any private health insurance plan held by a Medicare or commercial beneficiary, including Medigap policies or post-retirement benefits. Supplemental insurance usually pays the deductible or co [..]
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skilled nursing facility
A skilled nursing facility generally is an institution for convalescence or a nursing home. Skilled nursing facilities provide a high level of specialized care for long-term or acute illness.
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